哮喘患者急性加重期呼吸困难的感知及组胺相关支气管收缩

Perception of dyspnea during exacerbation and histamine-related bronchoconstriction in patients with asthma.

作者信息

Ekici Mehmet, Ekici Aydanur, Kara Turkan, Keles Hatice, Karlidag Ali, Altunkaya Volkan, Bulcun Emel

机构信息

Kirikkale University Faculty of Medicine, Department of Pulmonary Medicine, Turkey.

出版信息

Ann Allergy Asthma Immunol. 2006 May;96(5):707-12. doi: 10.1016/S1081-1206(10)61069-1.

DOI:10.1016/S1081-1206(10)61069-1

PMID:16729784

Abstract

BACKGROUND

Numerous studies have been performed concerning the perception of dyspnea during changes in airway caliber provoked in the laboratory setting, but studies of asthma exacerbation are scarce.

OBJECTIVE

To investigate whether the perception of dyspnea during histamine-induced bronchoconstriction might be used to identify patients with asthma who sense dyspnea poorly during exacerbation.

METHODS

The perception of dyspnea in 50 patients (45 female, 5 male) with asthma was evaluated at admission with exacerbation and during a stable period. Perceived intensity of dyspnea was estimated using a modified Borg scale. The perception of dyspnea in the stable period 4 to 6 weeks after exacerbation was measured with the histamine challenge test. Perception parameters were defined as the change in Borg score divided by the change in forced expiratory volume in 1 second (FEV1) as a percentage of the baseline FEV1 (deltaBorg/deltaFEV1) and as the Borg score at 20% decrease (PS20Histamine) or increase (PS20Exacerbation) in FEV1.

RESULTS

The perception of dyspnea during asthma exacerbation was unrelated to the perception of dyspnea during histamine-induced bronchoconstriction (for deltaBorg/deltaFEV1, beta = .08, P = .50; for PS20, beta = -.11, P = .40). The kappa value for the agreement of poor perceivers at exacerbation and during the stable period was -0.21 (P = .10). However, the intensity of dyspnea caused by histamine-induced bronchoconstriction was lower than that caused by asthma exacerbation (PS20: 1.6 +/- 1.1 vs 2.8 +/- 2.5, respectively, P = .004; deltaBorg/deltaFEV1: 0.08 +/- 0.05 vs 0.21 +/- 0.28, respectively, P = .001).

CONCLUSION

The perception of dyspnea during asthma exacerbation is not correlated with the perception of dyspnea during histamine-induced bronchoconstriction. Therefore, the perception of dyspnea during histamine-induced bronchoconstriction cannot be used to identify the asthmatic patients who perceive dyspnea poorly.

摘要

背景

关于在实验室环境中气道口径变化时呼吸困难的感知，已经进行了大量研究，但关于哮喘急性加重期的研究却很少。

目的

探讨组胺诱发支气管收缩期间的呼吸困难感知是否可用于识别在急性加重期呼吸困难感知较差的哮喘患者。

方法

对50例哮喘患者（45例女性，5例男性）在急性加重期入院时和病情稳定期的呼吸困难感知进行评估。使用改良的博格量表评估呼吸困难的感知强度。在急性加重期后4至6周的稳定期，通过组胺激发试验测量呼吸困难的感知。感知参数定义为博格评分的变化除以第1秒用力呼气容积（FEV1）的变化，并以基线FEV1的百分比表示（deltaBorg/deltaFEV1），以及FEV1下降20%（PS20组胺）或升高20%（PS20急性加重期）时的博格评分。

结果

哮喘急性加重期的呼吸困难感知与组胺诱发支气管收缩期间的呼吸困难感知无关（对于deltaBorg/deltaFEV1，β = 0.08，P = 0.50；对于PS20，β = -0.11，P = 0.40）。急性加重期和稳定期感知较差者一致性的kappa值为-0.21（P = 0.10）。然而，组胺诱发支气管收缩引起呼吸困难的强度低于哮喘急性加重期（PS20：分别为1.6±1.1和2.8±2.5，P = 0.004；deltaBorg/deltaFEV1：分别为0.08±0.05和0.21±0.28，P = 0.001）。